Nonpharmacological Strategies for Patients With Early-Stage Dementia or Mild Cognitive Impairment: A 10-Year Update.

As the incidence and prevalence of early-stage Alzheimer's disease and mild cognitive impairment increases worldwide, gerontological researchers continue to examine the efficacy and effectiveness of strategies to help patients and caregivers live with the disease. Although pharmacological treatments remain the focus of much of the research, nonpharmacological strategies and approaches to care continue to gain ground as effective means of improving the health-related quality of life for this patient population. The current commentary summarizes the state of the science based on a series of integrative and systematic reviews undertaken by the International Dementia Scholars Collaborative as a 10-year update to a previous white paper. Selected topics from this previous white paper (e.g., support groups, nutrition, exercise, cognitive training, falls) as well as new topics (e.g., mind-body, advance care planning, driving safety) are discussed, and recommendations for future research are provided. [Res Gerontol Nurs. 2017; 10(1):5-11.].

Effects of Support Groups for Individuals with Early-Stage Dementia and Mild Cognitive Impairment: An Integrative Review.

Support groups have demonstrated promising outcomes for individuals with mild cognitive impairment (MCI) and early-stage dementia (ESD) in previous literature reviews. However, evidence has not been updated since 2007. The current review aimed to update current evidence on the use and effects of support groups for individuals with MCI and ESD and their care partners. A literature search was conducted in seven databases and 18 eligible research articles were retrieved. Support groups showed positive impacts on participant acceptance of cognitive impairment; performance and satisfaction of meaningful activity; resilience; self-help; and care partner coping self-efficacy, perceived support, and preparation and task effectiveness. Findings also revealed that support groups were well accepted by participants and care partners. Few studies included ethnic diversity, limiting the generalizability of findings. Further large-scale studies are needed to confirm the effects of support groups for individuals with MCI and ESD in all populations. [Res Gerontol Nurs. 2017; 10(1):35-51.].

How Do We Promote Health?: From the Words of African American Older Adults With Dementia and Their Family Members.

As population diversity increases, understanding what health promotion means to ethnically diverse older adults and their family members aids in the design of health programming. This understanding is particularly relevant for the African American population who experience a high prevalence of Alzheimer's disease and related dementias (ADRD). The purpose of the current study was to describe family members' definition of health, health promotion activities (HPAs), barriers to HPAs, and the perceived effectiveness of HPAs for African American older adults with ADRD. A qualitative descriptive design was used to collect data from African American family caregivers (n = 26) and care recipients (n = 18). Transcripts, journals, and field notes were reviewed using inductive content analysis. Common health promotion activities included taking care of self, positive attitude on life, social engagement, spiritual and religious activity, stimulation and active movement, and financial stability. This research informs person-centered care strategies for African American families caring for older adults with ADRD. [Res Gerontol Nurs. 2016; 9(6):278-287.].

Developing the Person-Environment Apathy Rating for persons with dementia.

OBJECTIVES: To develop the Person-Environment Apathy Rating (PEAR) scale that measures environmental stimulation and apathy in persons with dementia and to evaluate its psychometrics. METHOD: The PEAR scale consists of the PEAR-Environment subscale and PEAR-Apathy subscales. The items were developed via literature review, field testing, expert review, and pilot testing. The construct validity and reliability were examined through video observation. The parent study enrolled 185 institutionalized residents with dementia. For this study, 96 videos were selected from 24 participants. The PEAR-Environment subscale was validated using the Ambiance Scale and the Crowding Index. The PEAR-Apathy subscale was validated using the Neuropsychiatric Inventory (NPI)-Apathy, Passivity in Dementia Scale (PDS), and NPI-Depression. RESULTS: The PEAR-Environment subscale and PEAR-Apathy subscales each consists of six items rated on a 1-4 scale. For validity, the Crowding Index slightly, yet significantly, correlated with the PEAR-Environment subscale total score and three of the individual scores. Ambiance Scale scores, both engaging and soothing, did not correlate with the PEAR-Environment subscale. The PEAR-Apathy highly correlated with the PDS and NPI-Apathy and moderately correlated with the NPI-Depression, suggesting good convergent validity and moderate discriminant validity. For reliability, both environment and apathy subscales demonstrated excellent internal consistency. Although facial expression and eye contact showed moderate inter-rater reliability, all other items showed good to excellent inter-rater and intra-rater reliability. CONCLUSION: This study has successfully developed the PEAR scale and established its psychometrics based on the compatible scales available. The PEAR scale is the first scale that concurrently assesses apathy and environmental stimulation, and is recommended for use in persons with dementia.

The Association Between Characteristics of Care Environments and Apathy in Residents With Dementia in Long-term Care Facilities.

PURPOSE: Apathy is highly prevalent in dementia but often overlooked. Environment-based interventions have demonstrated positive impact on apathy, yet, influential environmental components are largely understudied. This study examined the relationship between care environments and apathy in long-term care residents with dementia. DESIGN AND METHODS: This study was exploratory and employed a descriptive and repeated observation design. A sample of 40 was selected from a parent study with 185 participants from 28 facilities. Three videos from each participant were coded to measure apathy and environmental stimulation. Data on ambiance, crowding, staff familiarity, light, and sounds were extracted from the parent study. Generalized linear mixed models were used for analysis. RESULTS: The clarity and strength of environmental stimulation were significantly associated with a lower apathy level. An increase of 1 point on stimulation clarity and strength corresponded to a decrease of 1.3 and 1.9 points on apathy score, respectively (p < .0001). Other environmental factors did not show significant effect on apathy. IMPLICATIONS: This study explored influential environmental features on apathy in dementia. Findings suggest that care environments that contain clear and sufficient environmental stimulation are significantly associated with lower resident apathy levels. Findings will guide environmental design and interventions for dementia care.

Decisional involvement among staff nurses based on educational level and certification status.

Mechanisms to enhance the work environment are nurse decisional involvement (DI), obtainment of a baccalaureate or higher degree, and specialty certification. The purpose of this descriptive comparative study was to determine the difference between actual and preferred DI of staff nurses on the overall Decisional Involvement Scale (DIS), the differences based on its subscales, and those based on education level and certification. The sample included 163 staff nurses from a Midwestern health care organization. A statistically significant difference was found between actual and preferred DI, but no difference was found based on educational level and certification. There is a need to focus on nurses with a BSN/master's degree or specialty certification and to conduct comprehensive studies to address the effects of education and certification on DI. An additional strategy that can be useful for organizations is to provide nurses with the empowerment structures, expectations, and mentoring/coaching to become involved in the process of decision making.

Decisional involvement: actual and preferred involvement in decision-making among registered nurses.

Enhancing nurse involvement in decision-making is a starting point in addressing the nursing shortage, recruitment, and retention. The purpose of this descriptive comparative secondary data analysis was to describe the level of registered nurses' actual and preferred decisional involvement (DI) in two studies carried out during 2004 and 2010 and to describe the difference in the levels of actual and preferred DI between the 2004 study (N = 290) and the 2010 (N = 111) study in a Midwestern medical center after a new shared governance structure was implemented. In the 2004 and 2010 studies, there were statistically significant differences between actual and preferred levels of DI. A statistically significant decrease in means occurred in actual and preferred DI in 2010 as compared with that in 2004. A concerted effort must be made by nursing leaders to enhance DI, offer adequate resources, promote learning and growth, and recognize nursing contributions within a shared governance.

Evidence based practice in long term care settings.

PURPOSE: The purpose of this manuscript is to discuss the need for use of evidence based practice (EBP) in LTC, the current use of evidence in long term care facilities and what we know about adoption of the use of EBP in LTC. METHODS: Literature review and reporting of findings from the M-TRAIN study that was a quasi-experimental design to test the effectiveness of an intervention to increase the use of EBPs for urinary incontinence and pain in 48 LTC facilities. RESULTS: Barriers to adopting EBPs include lack of available time, lack of access to current research literature, limited critical appraisal skills, excessive literature to review, non-receptive organizational culture, limited resources, and limited decision-making authority of staff to implement change. Strategies to promote adoption of EBP include the commitment of management; the culture of the home; leadership; staff knowledge, time, and reward; and facility size, complexity, the extent that members are involved outside the facility, NH chain membership, and high level of private pay residents. Findings from the M-TRAIN add, stability of nurse leader and congruency between the leaders perception of their leadership and the staff's perception of the leadership. CONCLUSION: There is clear evidence of the need and the benefits to residents of LTC and to the health care system yet adoption of EBP continues to be slow and sporadic. There is also evidence for the process of establishing best evidence and many resources to find the available EBPs. The urgent need now is finding ways to best get the EBPs implemented in LTC. There is growing evidence about best methods to do this but continued research is needed. Clearly, residents in LTC deserve the best care possible and EBPs represent an important vehicle by which to do this.

Promoting continence in individuals with dementia.

Urinary incontinence (UI) is common in individuals with dementia as the disease progresses. The primary reasons for incontinence are often not related to pathology in the urinary system but are frequently attributed to losses associated with dementia. This article discusses the scope of the problem of UI in individuals with dementia, possible causes, and assessment methods, as well as interventions that can achieve improved outcomes.

Decisional involvement: staff nurse and nurse manager perceptions.

Enhancing involvement in organizational decisions is one strategy to improve the work environment of registered nurses and to increase their recruitment and retention. Little is known about the type of decision making and the level of involvement nurses desire. This was a descriptive study exploring staff nurse and nurse manager ratings of actual and preferred decisional involvement and differences between staff nurses and nurse managers. A sample of 320 RNs from a Midwestern health care network was surveyed using the Decisional Involvement Scale. Nurse managers and staff nurses had statistically significant differences in their perceptions of who was involved in actual decision making in the areas of unit governance and leadership and collaboration or liaison activities. There were statistically significant differences in preferred decisional involvement between staff nurses and nurse managers in the overall DIS scale and the subscales of unit governance and leadership and quality of support staff practice.

Aging issues: nursing imperatives for healthcare reform.

The people of the United States sent a clear message in November 2008 that they wanted a change in the nation's priorities, including healthcare. The question is whether healthcare reform will extend to the care of older adults, especially in the face of complex needs in the last years of their lives. This article addresses this question by examining the demographics of the older adult population, the eldercare workforce, and the current inadequate patchwork of financing. Some aging issues, such as chronic care, are being addressed in the broad context of healthcare reform, whereas health information technology and others remain marginal. The window of opportunity for a clear and coherent voice in a reformed/reshaped healthcare system is narrow. Now is the time for the "trusted" profession to advocate for meaningful change that will meet the current and future needs of older adults. The article concludes with strategies and Web-based resources for nurses to bring aging issues to the healthcare reform debate at both the national and local levels.

Effect of individualized music on agitation in individuals with dementia who live at home.

This pilot study investigated the effect of individualized music on agitation in individuals with dementia who live at home. Fifteen individuals listened to their preferred music for 30 minutes prior to peak agitation time, two times per week for 2 weeks, followed by no music intervention for 2 weeks. The process was repeated once. The findings showed that mean agitation levels were significantly lower while listening to music than before listening to the music. The findings of this pilot study suggest the importance of music intervention for individuals with dementia who live at home.

How to try this: Assessment of transient urinary incontinence in older adults.

Urinary incontinence in older adults is associated with an increased risk of institutionalization, as well as with urinary tract infections and depression. Transient urinary incontinence arises suddenly, lasts less than six months, and results from reversible causes. Many caregivers erroneously consider urinary incontinence to be inevitable in older adults, especially in hospitalized patients. Failure to identify and respond to transient urinary incontinence may lead to established incontinence and to other poor outcomes after hospital discharge. A bladder diary and a mnemonic are two methods nurses can use to assess for transient urinary incontinence and its treatable underlying causes. For a free online video showing nurses using these methods, go to http://links.lww.com/A311.

Needs of people with early-stage Alzheimer's disease: reviewing the evidence.

The focus of this literature search was on the needs of older adults with Alzheimer's disease (AD). Very little research has been published directly related to the concept of needs, so concepts were identified by implicitly pulling them from the foci of articles. Identified articles were written outside the framework of the person with AD-from the perspective of the providers and caregivers. To get the person's perspective, the search was expanded to find"self-identified" needs of the person with AD and by widening the medical subject heading terms. The collection of work found indicated retained awareness of the person with AD well into the disease process and that this awareness is not recognized by professionals or caregivers. The result is that older adults with AD are not consulted in determining their needs or having a voice in their plan of care. Also identified were the needs for early diagnosis, to be heard, for information and knowledge, for safety, health promotion, and emotional and cognitive support.

Partnering for care: the evidence and the expert.

Evidence supports the maintenance of self-awareness in individuals with Alzheimer's disease (AD) and the individuals' ability to identify their own needs. The need for individualized, person-centered programming may be met only if the perceptions of the individuals with AD are taken into account and valued. There is strong support for individuals with AD to be involved in developing their plan of care. Plans should include supportive and educational programs, individualized to the person's self-identified needs. Plans must also take into account preserved self-awareness and address preservation of self-esteem, maintenance of abilities, management of behavioral symptoms including depression, and health promotion. Second author Richard Taylor, who has dementia, noted the absence of discussion on this joint planning in most of the AD literature. As he says, it omits the most important person, the person with dementia.

Review of exemplar programs for adults with early-stage Alzheimer's disease.

In response to the need to develop evidence-based best practices interventions and services for individuals in the early stages of Alzheimer's disease (AD), the authors conducted an interdisciplinary literature review of exemplar programs, defined as those including multimodal or unimodal interventions; shown to be appropriate for individuals in the early stages of AD; demonstrating promise to support, maintain, and improve independent functioning; and shown to have positive effects for a variety of outcomes, including quality of life. This article examines evidence from five kinds of programs: (a) multimodal interventions, (b) programs developed by the Southwest Florida Interdisciplinary Center for Positive Aging, (c) sleep enhancement interventions, (d) managed care programs, and (e) technology-based interventions. Evidence from the review suggests that a number of programs can support functioning and improve quality of life for adults living with the early stages of memory loss. The article concludes with recommendations to advance a national research agenda in this area.

Interventions for residents with dementia and their family and staff caregivers: evaluating the effectiveness of measures of outcomes in long-term care.

This article describes six instruments developed for programs of research testing nursing interventions for individuals with dementia in Special Care Units and their family and staff caregivers. The Functional Abilities Checklist measures the functional abilities of residents with dementia. The Family Perceptions of Care Tool assesses family member satisfaction with care of the institutionalized relative with dementia. The Family Perceptions of Caregiving Role instrument evaluates stress experienced by family members of individuals with dementia related to their caregiving roles in long-term care settings. The Caregiver Stress Inventory and Staff Perceptions of Caregiving Role tools measure staff stress related to caring for residents with dementia. Finally, the Attitudes About Families Checklist assesses general staff attitudes about families of residents with dementia. Each instrument and its psychometric properties are described. The advantages of these instruments for research and clinical use with individuals with dementia are discussed.

9 myths of incontinence in older adults: both clinicians and the over-65 set need to know more.

Despite progress made in the research into and treatment of urinary incontinence, its incidence is rising among older adults. Many reasons for this disturbing finding have been posed: clinicians' insufficient knowledge of urinary incontinence, the reluctance of patients to discuss it, and inadequately individualized care. Common misconceptions of bladder health in older adults are explored to address these concerns and help prepare nurses in all settings to provide care that prevents and treats incontinence.